Bilateral giant adrenal myelolipoma: A rare scenario

Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.

Tunica vaginalis flap – is it a better surgical choice for urethro-cutaneous fistula following circumcision?

Objective: To study the effectiveness of tunica vaginalis flap in repair of post circumcision urethro- cutaneous fistula. Materials and Methods: The current study reviewed all patients having surgical repair of post-circumcision urethrocutaneous fistula from December 2014 to April 2019 at our institution. Results: Ten cases presenting at age 5 to 22 years were operated. Most [60%] of the circumcisions were performed by a doctor at peripheral hospitals and others were done by traditional circumcisers. All cases had a single fistula and the size was more than 5mm in all cases. Three-layered fistula closure was done in all cases using the tunica vaginalis flap as the second layer for closure. There was no recurrence in any case. Conclusion: Use of Tunica vaginalis flap for repair of post circumcision urethro-cutaneous fistula is a highly effective technique regardless of size and site of the fistula. It is a simple procedure without any postoperative complications and without any recurrence

Perception of living kidney donors after taking a decision of kidney donation and their perception of the quality of life after kidney donation

Background: With increasing renal transplantation surgeries, the living donor renal transplant is being promoted, majorly due to the shortage of renal graft from deceased persons and potential benefits of living kidney donation itself. It is a complex phenomenon, better studied by the qualitative analysis which allows a complementary in-depth exploration of complex human experiences in such cases. This study adds to the existing literature of qualitative research covering the analysis of decision-making, perioperative, and post-operative period. Objectives: Our aim was to explore the donation process of a heterogeneous group of genetically and non-genetically related living kidney donors, to know their perception during the decision and quality of life after kidney donation. The objectives were to know the factors involved in decision-making process, the psychological status after committing for donation and to explore the changes in individual’s life post-donation. Materials and Methods: It is a thematic study with descriptive approach, with non-probability, purposive sampling of participants. In-depth interviews were analyzed by interpretative phenomenological analysis. Results were created through a comprehensive range of constituent themes and master themes after analysis of transcripts. Results: The decision-making is a rapid, rational, and altruist process. Reassurance and better management of psychological experience during the pre-operation period is helpful to a great extent. The increase in self-esteem is almost universal except a few cases of negative impact after donation. Conclusion: This study will not only help in better understanding of pre-surgical preparation but also for the better management of post-operative and follow-up period.

A qualitative study on the perceptions of patients with vesicovaginal fistula

Background: Vesicovaginal fistula (VVF) is a grave complication of gynecological surgeries and vaginal deliveries, leading to physical, psychological, and social implications. In India, due to the high patient turnover, it is not uncommon to find such patients in every region. While various works elaborate the surgical aspect of VVF, there is a dearth of literature on qualitative research. Objective: This study was done to better understand the impact of physical, psychological, and social factors on the lives of patient with VVF. Materials and Methods: This study was conducted in the department of urology at a tertiary care hospital. It was a descriptive qualitative study that involved audio recorded in-depth interviews of 18 such patients followed by their transcription and qualitative data analysis. Results: We identified five major categories from the transcripts, namely, understanding of the disease, initial reaction of the patient, reaction of the husband and family, personal and physical discomfort, and social implications. While majority of the perceptions were also reported in the previous studies, we found some unique perceptions in the form of false perception of urine leak from urethra in spite of vagina and blaming, the birth of female child for bad luck was found in our study. Another favorable unique response not noted in other studies was excellent family support in half of the patients. Conclusion: Our study supports the idea that VVF has far deeper implications other than physical discomfort. This study promotes wholesome management of patients, family, and society using a multidisciplinary approach.

Work stress on resident doctors in a tertiary care hospital in Eastern India: A qualitative study from the outlook of residents

Background: Hospitals present a complex and challenging environment to resident doctors. The perception of ever-increasing work stress on residents has been the topic for multiple studies previously. In this study, we explore the perspective of resident doctors working in a premier tertiary care hospital in Eastern India about their work stress. Objectives: The objectives of the study were to investigate the causes of work stress on residents in a tertiary care hospital in Eastern India and to find out the perceived solutions to ease the work stress on residents. Materials and Methods: The study was done in the department of urology at a tertiary health care center in Eastern India. The study comprised of in depth interviews and focus group discussions. The interviews were audio recorded and later transcripted. Data analysis was done through deductive approach. Results were reviewed by all the authors. Results: Work stress on residents was considered to be additional pressure which was in excess of individual capacity and led to work and personal life imbalance and depression among residents. The principal causes were lack of manpower and infrastructure, inadequate time for family, political influence in hospital functioning, and role of media in causing and aggravating patient distrust on doctors. It had a harmful effect on academic learning of residents. A combined and sustained effort is needed to reduce the work stress to improve performance and patient outcomes. Conclusion: Persistent and disproportionate work stress on residents leads to their poor work–life balance and depression and translates into poor performance and patient outcomes. The problem is multi-factorial and solutions can be found out by a concerted effort from the hospital administration, political class, and media. Mutual trust among doctors and patients can play the most important role to reduce resident work stress.